Endocrine Practice

Which hormone is released in response to stress? -Oxytocin -Calcitonin -Adrenaline -Somatostatin

-Adrenaline **In stress conditions, adrenaline is released; it enhances and prolongs the effects of parasympathetic system.

Which hormone is associated with fostering growth of the adrenal cortex? -Oxytocin -Somatostatin -Growth hormone -Adrenocorticotropic hormone (ACTH)

-Adrenocorticotropic hormone (ACTH) **ACTH fosters the growth of the adrenal cortex

Which hormone is essential for the maintenance of fluid and electrolyte balance? -Cortisol -Androgens -Adrenaline -Aldosterone

-Aldosterone **Mineralocorticoids are essential for the maintenance of fluid and electrolyte balance; aldosterone is an example of a mineralocorticoid.

Which hormone is referred to as the "fight or flight" hormone? -Cortisol -Estrogen -Epinephrine -Aldosterone

-Epinephrine **Epinephrine is a catecholamine secreted by the adrenal medulla. It is released during stressful conditions and results in the "fight or flight" response. **Cortisol, estrogen, and aldosterone are steroidal hormones secreted by the adrenal cortex.

Which hormone deficiency would the nurse expect to find in the diagnostic report of a female patient with abnormal breast development? -Insulin -Estrogen -Testosterone -Corticosteroids

-Estrogen ** Estrogen deficiency can lead to abnormal female breast development because it promotes female secondary sex trait development.

Which cue would be noted during assessment in a patient with exophthalmos due to hyperthyroidism? -Edema -Hirsutism -Constipation -Eyeball protrusion

-Eyeball protrusion **exophthalmos is the term for eyeball protrusion which is common in patients with hyperthyroidism. It happens due to fluid buildup in the retro orbital tissue.

Which hormone stimulates the process of gluconeogenesis and glycogenolysis? -Insulin -Cortisol -Glucagon -Aldosterone

-Glucagon **Glucagon stimulate the process of gluconeogenesis and glycogenolysis and increases blood glucose.

Which statement describes how to conduct the test for Trousseau sign? -Depress the skin over the sternum for 1 minute. -Observe for circumoral twitches following speaking. -Tap two fingers anterior to the front of the patient's ear. -Inflate a blood pressure (BP) cuff above the antecubital space.

-Inflate a blood pressure (BP) cuff above the antecubital space. **Trousseau sign is a diagnostic tool that is used to assess for tetany, a sign of hypoglycemia. Muscle spasms of the hand elicited on application of an occlusive BP cugg for 3 minutes may occur in hypoparathyroidism.

Which hormone is secreted in response to an increased blood glucose level? -Insulin -Catecholamines -Glucagon -Somatostatin

-Insulin **Insulin is the principal regulator of metabolism and storage of ingested carbohydrates, fats, proteins. An increased blood glucose level is the major stimulus for the synthesis and secretion of insulin.

Which organ is targeted by the hormone produced by the parathyroid glands? -Uterus -Breasts -Kidneys -Pancreas

-Kidneys **The parathyroid glands produce parathyroid hormone (PTH), which targets the bone, intestinal, and kidney tissues.

Which hormone will be decreased is there is damage to the pineal gland? -Insulin -Cortisol -Melatonin -Calcitonin

-Melatonin **The pineal gland, located in the brain, secretes the hormone melatonin. Damage to this gland leads to altered regulation of melatonin in the patient; therefore there would be low levels of melatonin in the laboratory reports of a patient who has damnaged the pineal gland.

Which hormone stimulates milk secretion in a patient postpartum? -Insulin -Oxytocin -Epinephrine -Parathormone

-Oxytocin **Oxytocin targets the mammary glands in patients postpartum and stimulates milk secretion.

Which assessment finding supports the diagnosis of Cushing syndrome? -Purplish red marks on the abdomen -Blood pressure (BP) 90/60 -Hyperreflexia -Hair loss

-Purplish red marks on the abdomen **Signs and symptoms of Cushing syndrome are caused by excessive levels of circulating serum cortisol and include periorbital edema; striae on the chest, abdomen, and buttocks; moon facel and hypertension.

The home health nurse visits a client with a diagnosis of type 1 diabetes mellitus. The client relates a history of vomiting and diarrhea and tells the nurse that no food has been consumed for the last 24 hours. Which additional statement by the client indicates a need for further teaching? 1. "I need to stop my insulin." 2. "I need to increase my fluid intake." 3. "I need to monitor my blood glucose every 3 to 4 hours." 4. "I need to call the primary health care provider (PHCP) because of these symptoms."

1. "I need to stop my insulin." **When a client with diabetes mellitus is unable to eat normally because of illness, the client still needs to take the prescribed insulin or oral medication. The client would consume additional fluids and needs to notify the PHCP. The client needs to monitor the blood glucose level every 3 to 4 hours. The client would also monitor the urine for ketones during illness.

A client arrives in the hospital emergency department in an unconscious state. As reported by the spouse, the client has diabetes mellitus and began to show symptoms of hypoglycemia. A blood glucose level is obtained for the client, and the result is 40 mg/dL (2.28 mmol/L). Which medication would the nurse anticipate will be prescribed for the client? 1. Glucagon 2. Glyburide 3. Metformin 4. Regular insulin

1. Glucagon **A blood glucose level lower than 50 mg/dL (2.85 mmol/L) is considered to be critically low. Glucagon is used to treat hypoglycemia because it increases blood glucose levels. Insulin would lower the client's blood glucose and would not be an appropriate treatment for hypoglycemia. Glyburide and metformin are oral hypoglycemic agents used to treat type 2 diabetes mellitus and would not be given to a client with hypoglycemia. In addition, an oral medication would not be administered to an unconscious client.

The nurse is admitting a client who is diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH) and has serum sodium of 118 mEq/L (118 mmol/L). Which prescriptions would the nurse anticipate receiving? Select all that apply. 1. Initiate an infusion of 3% NaCl. 2. Administer intravenous furosemide. 3. Restrict fluids to 800 mL over 24 hours. 4. Elevate the head of the bed to high-Fowler's. 5. Administer a vasopressin antagonist as prescribed.

1. Initiate an infusion of 3% NaCl. 3. Restrict fluids to 800 mL over 24 hours. 5. Administer a vasopressin antagonist as prescribed. **Clients with SIADH experience excess secretion of antidiuretic hormone (ADH), which leads to excess intravascular volume, a declining serum osmolarity, and dilutional hyponatremia. Management is directed at correcting the hyponatremia and preventing cerebral edema. Hypertonic saline is prescribed when the hyponatremia is severe, less than 120 mEq/L (120 mmol/L). An intravenous (IV) infusion of 3% saline is hypertonic. Hypertonic saline must be infused slowly as prescribed, and an infusion pump must be used. Fluid restriction is a useful strategy aimed at correcting dilutional hyponatremia. Vasopressin is an ADH; vasopressin antagonists are used to treat SIADH. Furosemide may be used to treat extravascular volume and dilutional hyponatremia in SIADH, but it is only safe to use if the serum sodium is at least 125 mEq/L (125 mmol/L). When furosemide is used, potassium supplementation would also occur and serum potassium levels would be monitored. To promote venous return, the head of the bed would not be raised more than 10 degrees for the client with SIADH. Maximizing venous return helps to avoid stimulating stretch receptors in the heart that signal to the pituitary that more ADH is needed.

The nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of complications. Which sign or symptom, if exhibited in the client, indicates that the client is at risk for chronic complications of diabetes if the blood glucose is not adequately managed? 1. Polyuria 2. Diaphoresis 3. Pedal edema 4. Decreased respiratory rate

1. Polyuria **Chronic hyperglycemia, resulting from poor glycemic control, contributes to the microvascular and macrovascular complications of diabetes mellitus. Classic symptoms of hyperglycemia include polydipsia, polyuria, and polyphagia.

The nurse is completing an assessment on a client who is being admitted for a diagnostic workup for primary hyperparathyroidism. Which client complaint would be characteristic of this disorder? Select all that apply. 1. Polyuria 2. Headache 3. Bone pain 4. Nervousness 5. Weight gain

1. Polyuria 3. Bone pain **The role of parathyroid hormone (PTH) in the body is to maintain serum calcium homeostasis. In hyperparathyroidism, PTH levels are high, which causes bone resorption (calcium is pulled from the bones). Hypercalcemia occurs with hyperparathyroidism. Elevated serum calcium levels produce osmotic diuresis and thus polyuria. This diuresis leads to dehydration (weight loss rather than weight gain). Loss of calcium from the bones causes bone pain. Options 2, 4, and 5 are not associated with hyperparathyroidism. Some gastrointestinal symptoms include anorexia, nausea, vomiting, and constipation.

A client with diabetes mellitus is being discharged following treatment for hyperosmolar hyperglycemic syndrome (HHS) precipitated by acute illness. The client tells the nurse, "I will call my doctor the next time I can't eat for more than a day or so." Which statement reflects the most appropriate analysis of this client's level of knowledge? 1. The client needs immediate education before discharge. 2. The client requires follow-up teaching regarding the administration of oral antidiabetics. 3. The client's statement is inaccurate, and the client needs to be scheduled for outpatient diabetic counseling. 4. The client's statement is inaccurate, and the client needs to be scheduled for educational home health visits.

1. The client needs immediate education before discharge. **If the client becomes ill and cannot retain fluids or food for a period of 4 hours, the physician needs to be notified. The client's statement indicates a need for immediate education to prevent hyperosmolar hyperglycemic syndrome (HHS), a life-threatening emergency. Although all of the other options may be true, the most appropriate analysis is that the client requires immediate education.

A client with type 1 diabetes mellitus calls the nurse to report recurrent episodes of hypoglycemia with exercising. Which statement by the client indicates an adequate understanding of the peak action of NPH insulin and exercise? 1. "I would not exercise since I am taking insulin." 2. "The best time for me to exercise is after breakfast." 3. "The best time for me to exercise is mid- to late afternoon." 4. "NPH is a basal insulin, so I need to exercise in the evening."

2. "The best time for me to exercise is after breakfast." **Exercise is an important part of diabetes management. It promotes weight loss, decreases insulin resistance, and helps to control blood glucose levels. A hypoglycemic reaction may occur in response to increased exercise, so clients need to exercise either an hour after mealtime or after consuming a 10- to 15-gram carbohydrate snack, and they would check their blood glucose level before exercising. **Option 3 in incorrect; clients need to avoid exercise during the peak time of insulin. NPH insulin peaks at 4 to 12 hours; therefore, afternoon exercise takes place during the peak of the medication. Option 4 is incorrect; NPH insulin in an intermediate-acting insulin, not a basal insulin.

A client with Cushing's syndrome is anxious and verbalizes concern to the nurse regarding the appearance of the buffalo hump that has developed. Which statement would the nurse plan to make to the client? 1. "Don't be concerned; this problem can be covered with clothing." 2. "Usually these physical changes slowly improve following treatment." 3. "This is permanent, but looks are deceiving and are not that important." 4. "Try not to worry about it; there are other things to be concerned about."

2. "Usually these physical changes slowly improve following treatment." **The client with Cushing's syndrome need to be reassured that most physical changes resolve with treatment. All other options are not therapeutic responses.

The nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that a form of glucose would be taken if which symptom or symptoms develop? Select all that apply. 1. Polyuria 2. Shakiness 3. Palpitations 4. Blurred vision 5. Light-headedness 6. Fruity breath odor

2. Shakiness 3. Palpitations 5. Light-headedness **Shakiness, palpitations, and light-headedness are signs/symptoms of hypoglycemia and would indicate the need for food or glucose. **Polyuria, blurred vision, and a fruity breath odor are manifestations of hyperglycemia.

The nurse is reviewing the laboratory test results for a client with a diagnosis of Cushing's syndrome. Which laboratory finding would the nurse expect to note in this client? 1. A platelet count of 200,000 mm3 (200 × 109/L) 2. A blood glucose level of 99 mg/dL (5.5 mmol/L) 3. A potassium (K+) level of 3.0 mEq/L (3.0 mmol/L) 4. A white blood cell (WBC) count of 6000 mm3 (6 × 109/L)

3. A potassium (K+) level of 3.0 mEq/L (3.0 mmol/L) **The client with Cushing's syndrome experiences hypokalemia, hyperglycemia, an elevated WBC count, elevated plasma cortisol and adrenocorticotropic hormone levels among other abnormalities. These abnormalities are caused by the effects of excess glucocorticoids and mineralocorticoids in the body. The normal potassium level is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L).

The nurse would include which interventions in the plan of care for a client with hyperthyroidism? Select all that apply. 1. Provide a warm environment for the client. 2. Instruct the client to consume a low-fat diet. 3. A thyroid-releasing inhibitor will be prescribed. 4. Encourage the client to consume a well-balanced diet. 5. Instruct the client that thyroid replacement therapy will be needed. 6. Instruct the client that episodes of chest pain are expected to occur.

3. A thyroid-releasing inhibitor will be prescribed. 4. Encourage the client to consume a well-balanced diet. **The clinical manifestations of hyperthyroidism are the result of increased metabolism caused by high levels of thyroid hormone. Interventions are aimed at reduction of the hormones and measures to support the signs and symptoms related to an increased metabolism. The client often has heat intolerance and requires a cool environment. The nurse encourages the client to consume a well-balanced diet because clients with this condition experience increased appetite. Iodine preparations are used to treat hyperthyroidism. Iodine preparations decrease blood flow through the thyroid gland and reduce the production and release of thyroid hormone. Thyroid replacement is needed for hypothyroidism. The client would notify the primary health care provider if chest pain occurs because it could be an indication of an excessive medication dose.

A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial blood glucose level is 950 mg/dL (54.2 mmol/L). A continuous intravenous (IV) infusion of short-acting insulin is initiated, along with IV rehydration with normal saline. The serum glucose level is now decreased to 240 mg/dL (13.7 mmol/L). The nurse would next prepare to administer which medication? 1. An ampule of 50% dextrose 2. NPH insulin subcutaneously 3. IV fluids containing dextrose 4. Phenytoin for the prevention of seizures

3. IV fluids containing dextrose **Emergency management of DKA focuses on correcting fluid and electrolyte imbalances and normalizing the serum glucose level. If the corrections occur too quickly, serious consequences, including hypoglycemia and cerebral edema, can occur. During management of DKA, when the blood glucose level falls to 250 to 300 mg/dL (14.2 to 17.1 mmol/L), the IV infusion rate is reduced and a dextrose solution is added to maintain a blood glucose level of about 250 mg/dL (14.2 mmol/L), or until the client recovers from ketosis.

The nurse would include which interventions in the plan of care for a client with hypothyroidism? Select all that apply. 1. Provide a cool environment for the client. 2. Instruct the client to consume a high-fat diet. 3. Instruct the client about thyroid replacement therapy. 4. Encourage the client to consume fluids and high-fiber foods in the diet. 5. Inform the client that iodine preparations will be prescribed to treat the disorder. 6. Instruct the client to contact the primary health care provider (PHCP) if episodes of chest pain occur.

3. Instruct the client about thyroid replacement therapy. 4. Encourage the client to consume fluids and high-fiber foods in the diet. 6. Instruct the client to contact the primary health care provider (PHCP) if episodes of chest pain occur. **The clinical manifestations of hypothyroidism are the result of decreased metabolism from low levels of thyroid hormone. Interventions are aimed at replacement of the hormone and providing measures to support the signs and symptoms related to decreased metabolism. The client often has cold intolerance and requires a warm environment. The nurse encourages the client to consume a well-balanced diet that is low in fat for weight reduction and high in fluids and high-fiber foods to prevent constipation. The client is instructed to notify the PHCP if chest pain occurs because it could be an indication of overreplacement of thyroid hormone. **Iodine preparations may be used to treat hyperthyroidism. Iodine preparations decrease blood flow through the thyroid gland and reduce the production and release of thyroid hormone; they are not used to treat hypothyroidism.

A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperosmolar hyperglycemic syndrome is made. The nurse would immediately prepare to initiate which anticipated prescription? 1. Endotracheal intubation 2. 100 units of NPH insulin 3. Intravenous infusion of normal saline 4. Intravenous infusion of sodium bicarbonate

3. Intravenous infusion of normal saline **The primary goal of treatment in hyperosmolar hyperglycemic syndrome (HHS) is to rehydrate the client to restore fluid volume and to correct electrolyte deficiency. Intravenous (IV) fluid replacement is similar to that administered in diabetic ketoacidosis (DKA) and begins with IV infusion of normal saline. **Regular insulin, not NPH insulin, would be administered. The use of sodium bicarbonate to correct acidosis is avoided because it can precipitate a further drop in serum potassium levels. Intubation and mechanical ventilation are not required to treat HHS.

A client has just been admitted to the nursing unit following thyroidectomy. Which assessment is the priority for this client? 1. Hypoglycemia 2. Level of hoarseness 3. Respiratory distress 4. Edema at the surgical site

3. Respiratory distress **Thyroidectomy is the removal of the thyroid gland, which is located in the anterior neck. It is very important to monitor airway status, as any swelling to the surgical site could cause respiratory distress. Although all of the options are important for the nurse to monitor, the priority nursing action is to monitor the airway.

A client with type 1 diabetes mellitus is to begin an exercise program, and the nurse is providing instructions regarding the program. Which instruction would the nurse include in the teaching plan? 1. Try to exercise before mealtimes. 2. Administer insulin after exercising. 3. Take a blood glucose test before exercising. 4. Exercise is best performed during peak times of insulin.

3. Take a blood glucose test before exercising. **A blood glucose test performed before exercising provides the client with information regarding the need to consume a snack before exercising. Exercising during the peak times of insulin or before mealtimes places the client at risk for hypoglycemia. Insulin needs to be administered as prescribed.

The nurse performs a physical assessment on a client with type 2 diabetes mellitus. Findings include a fasting blood glucose level of 120 mg/dL (6.8 mmol/L), temperature of 101° F (38.3° C), pulse of 102 beats/minute, respirations of 22 breaths/minute, and blood pressure of 142/72 mm Hg. Which finding would be the priority concern to the nurse? 1. Pulse 2. Respiration 3. Temperature 4. Blood pressure

3. Temperature **In the client with type 2 diabetes mellitus, an elevated temperature may indicate infection. Infection is a leading cause of hyperosmolar hyperglycemic syndrome in the client with type 2 diabetes mellitus.

The nurse is caring for a client after thyroidectomy. The nurse notes that calcium gluconate is prescribed for the client. The nurse determines that this medication has been prescribed for which purpose? 1. To treat thyroid storm 2. To prevent cardiac irritability 3. To treat hypocalcemic tetany 4. To stimulate release of parathyroid hormone

3. To treat hypocalcemic tetany **Hypocalcemia, resulting in tetany, can develop after thyroidectomy if the parathyroid glands are accidentally removed during surgery. Manifestations develop 1 to 7 days after surgery. If the client develops numbness and tingling around the mouth, fingertips, or toes; muscle spasms; or twitching, the primary health care provider is notified immediately. Calcium gluconate needs to be readily available in the nursing unit.

The nurse is caring for a client scheduled for a transsphenoidal hypophysectomy. The preoperative teaching instructions would include which statement? 1. "Your hair will need to be shaved." 2. "You will receive spinal anesthesia." 3. "You will need to ambulate after surgery." 4. "Brushing your teeth needs to be avoided for at least 2 weeks after surgery."

4. "Brushing your teeth needs to be avoided for at least 2 weeks after surgery." **A transsphenoidal hypophysectomy is a surgical approach that uses the nasal sinuses and nose for access to the pituitary gland.

A client arrives in the hospital emergency department complaining of severe thirst and polyuria. The client tells the nurse that they have a history of diabetes mellitus. A blood glucose level is drawn, and the result is 685 mg/dL (39.1 mmol/L). Which intervention would the nurse anticipate to be prescribed initially for the client? 1. Glyburide via the oral route 2. Glucagon via the subcutaneous route 3. Insulin aspart via the subcutaneous route 4. Regular insulin via the intravenous (IV) route

4. Regular insulin via the intravenous (IV) route **The client is most likely in diabetic ketoacidosis (DKA). Regular insulin via the IV route is the preferred treatment for DKA. Regular insulin is a short-acting insulin and can be given intravenously; it is titrated to the client's high blood glucose levels.